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April 10, 2002


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JAMA. 2002;287(14):1862. doi:10.1001/jama.287.14.1862-JMS0410-7-1

I am walking down a small street. The heat is unbearable. I can feel the sun bathing, burning my skin. It is an abrasive, almost painful sensation, but I am happy. Let it burn, even if I get skin cancer one day. There are things that matter in life and this isn't one of them today. Last night, I saw a 3-year-old girl die on the operating table after falling in the bathtub and cracking her skull on the faucet. The suffocating August air, the sun, and the smell of the exhaust from a truck idling at the traffic light are not at all unpleasant this evening. It's 5:20. I should hurry, the barber shop is closing in 10 minutes. If I get there at 5:25, will they still cut my hair? So what if I will make them work a bit overtime today. I hope they'll work overtime for me. I would do it for them.

I am a third-year medical student at the end of my first month at the hospital. I started work at 5:30 this morning, so I could finish by 5:00 PM and get a haircut. I woke my patient at 5:35 to do the daily physical exam. The 73-year old woman was groggy and angry and told me to go to hell. "I'm sorry, I need to do this now." I am lying. I can do it four hours later, but that means one more day without a haircut. It's okay, I tell myself. When I get more efficient at this, I won't have to wake them this early. Mrs Jones will wake up at 5:35 today, so my patients in the future won't have to. Then I tell myself I'm full of it and laugh. The truck exhaust smells different and sweet, unfamiliar. I am now more used to the smell of feet, armpits, pus and sweat, vomit, soap and coffee. Coffee . . . It's been too long since my last cup. Hospital coffee is terrible, but beggars can't be choosers. My last patient, 33, has injected cocaine since he was 16. "I tried to stop, but I need it, man." I smile, knowingly, respectful of his habit. I am also afraid of him. "Watch the needle. Don't get stuck . . . "—a mantra in my mind as I struggle through a procedure.

An unshaven man in dirty clothes is walking past me. Our eyes meet; I smile and nod. A month ago I would have looked away. But too many people look like him at the hospital, and I always smile and nod. Sometimes, I do it because I like them; often, because I feel bad about their pain; once in a while, to conceal my horror and disgust. I see things that make me sick and scared, and I take pride in my ability to hide my emotions from patients. I think it will make me a better doctor. Maybe not.

As I sit in the barber's chair, he smiles and nods. I wonder what he really thinks. "The usual?" I say yes and thank him. Wow. It's been two months since he cut my hair. I am impressed and envious. All my patients seem to blend together, almost faceless, remembered by their age, symptoms, and the picture of their tumor on the MRI. My teachers say they remember patients as people. Until I do, I hope patients forgive me. Or maybe I don't really care. I try to take good care of all of them, I care about many of them, but I hardly ever worry if they care about me. That way, if they hate me, it doesn't hurt as much. Because I try never to hate them back. I work overtime for them. Maybe they'll do it for me one day.

Editor's Note:
Please send murmur submissions (personal essays, fiction, or poetry on either medical or nonmedical topics) to Teri Reynolds at treynol@itsa.ucsf.edu.